Autistic Symptoms Make Higher Risk for Substance Abuse

Generally, people on the autism spectrum tend to be personally cautious and socially withdrawn. As you would expect, previous research shows that people with autism tend to have low rates of substance abuse – the preference for low risk and avoidance of social situations means less drinking or drug use. But new research from the Washington University School of Medicine found the opposite: in their study of 3,080 Australian twins, people with symptoms of autism were more likely than people without symptoms to abuse alcohol and marijuana. The interesting reason why and perhaps implications for protecting both autistic people and those who happen to be socially withdrawn are inside their fascinating research.

First, people on the autism spectrum are a tricky group to study–because the spectrum includes many people with mild symptoms like those of Asperger’s syndrome, the less extreme side of the spectrum which may go undiagnosed. And so instead of studying people formally diagnosed with autism, in this case the researchers asked people about their symptoms that tend to be related to autism. How would alcohol and marijuana use correlate with symptoms like social-interaction difficulties, communication challenges and a tendency to engage in repetitive behaviors?

Interestingly, what they found is that people with autistic traits were no more likely to drink or use marijuana than people without these traits, but that people with autistic traits who drank or smoked pot were more likely to become addicted to or otherwise abuse these substances.

In their study, just under 20 percent of twins without autistic traits met the criteria for alcoholism. But of people with autistic traits, 35 percent were alcohol-dependent. With marijuana, 23 percent of the controls had used marijuana more than 10 times in their lives, compared with 39 percent of people with 6 or more autistic symptoms.

In a press release accompanying the research, Duneesha De Alwis, PhD, a postdoctoral fellow in the Department of Psychiatry, wrote, “People with autistic traits can be socially withdrawn, so drinking with peers is less likely. But if they do start drinking, even alone, they tend to repeat that behavior, which puts them at increased risk for alcohol dependence.”

But what about previous findings that people with autism are protected from substance abuse? The answer, according to the researchers, is the difference between symptoms and diagnosis. Think about it: a diagnosis is likely to accompany a more extreme form of the disorder. And it seems from this research as if a more extreme form of the disorder may keep autistic people from even experimenting with substances.

But then at the level of individual symptoms or even clusters of symptoms, “It could be that some traits related to autism are protective, while others elevate the risk for alcohol and substance-abuse problems,” says Arpana Agrawal, PhD, associate professor of psychiatry at the university.

If autism itself is protective, autistic tendencies may be a risk factor for substance abuse. Which autistic symptoms increase the risk? Are people with only one or two autistic tendencies at higher risk or are there tipping points on the spectrum that increase and then decrease risk? Agarwal, De Alwis and colleagues are asking these questions in further research. For the time being, I would love to hear your experience with autism, symptoms that could be considered autistic, and substance abuse. What’s your take on the intersection of these challenges?

To start with, I'm often a bit wary of broad generalizations, or the potential that the public might make them based on studies such as this. Substance abuse has a huge stigma attached, and so does autism. I worry about how people not familiar with autism will process the two together.

That said, I've had a few people in my life who had autism or ADHD traits and issues with addiction, so I've had a considerable amount of reason to be interested in this scenario. In observing the people in my own life, my suspicion/theory has been that the substance use was a form of self-medication.

I'm not at all surprised that the results show that people with traits who do not have a diagnosis are more likely to have problems in this area, but the reasons it makes sense to me differs from the ones cited by you and the study authors. I'm not sure it has to do with severity of symptoms, and I don't buy the casual assumption that if you have a diagnosis your traits are more severe (or as I would put it, more readily observable). Sure, it's true that longstanding diagnoses in adults would by default have to have met earlier, more strict diagnostic criteria (for example, they would not have been diagnosed with Asperger's before 1994)...but I don't think it's quite as simple as it's made out to be in the press release.

There are all kinds of factors that are at play with regard to diagnosis that have nothing to do with the way autism manifests in a person. Things like access to knowledgeable health care providers, socio-economic status, and race. It's not surprising that if you live near an autism center, you're more likely to be diagnosed. Certainly, if autistic traits are more obvious, it's harder to slip under the radar, but it can happen. Especially if you're rarely seen by a doctor at all, let alone one that is knowledgeable about autism.

All that said, my observation with regard to the people in my own life was that substances were used as a tool to mitigate the anxiety and depression that often comes with the challenges of surviving as an autistic person in the world. Especially, when you're not diagnosed and thus don't have a vocabulary for understanding what's going on. Those of us who've had to live most, if not all, of our adult lives without the self-awareness a diagnosis can bring, have had a very rough road of it. Life threw us into the deep end to try to figure it out all by ourselves, and we've simply had to just try to figure out what worked by trial and error.

For some, substances have served as a coping mechanism. For example, the researchers are very straight forward in their assumptions that autistic adults would obviously not drink socially. My observation was that it wasn't true in the case of the individuals I'm talking about, at least not entirely. Certainly, if they're thinking of binge drinking, and other such things, I can say, yes, that fit. However, socializing and drinking were very connected in a couple of cases. In those situations, it was not so much "social drinking" as "drinking TO BE social."

Let me give you an example -- a family member. I never saw him socialize without a drink in his hand. His main forms of socializing outside the family were twofold -- he would hang out at the bar with coworkers after work, and he would participate in dinner parties my mother arranged. In both cases, alcohol was always consumed. I came to understand it this way: He was naturally gruff and lacked social graces. Socializing was hard for him, and I imagine drove a considerable amount of anxiety on this part. Since alcohol lowers inhibition, it helped him to get past that anxiety and self-consciousness and be able to socialize. Thus, it became a crucial thing for him.

When pressured to give it up for medical reasons, he fought tooth and nail -- which was strange given that in other areas he was ruthlessly logical. This was a man who did geometry proofs for fun. But my theory always was that he clung to it because it worked, and he had no other tools in his toolbox to allow him to manage his social anxiety, and without managing that social anxiety, he couldn't get the social contact that he really wanted. In his mind, giving up alcohol meant giving up the social successes he'd managed to achieve in our little circle, and would mean living with unbearable anxiety (as he also tended to use it to manage other stresses in life). It was sad, in that that choice ultimately played a part in the illnesses that led to his death.

The reason it makes sense to me that those who ARE diagnosed are less likely to have issues in this area is that if you're diagnosed, you've likely done so in order to get treatment or counseling for the challenges that can come alongside autism. If the care provider is worth their salt, they would provide effective methods for mitigating things like anxiety and depression. A good counselor would or should be able to give a person struggling in the types of situations he was dealing with and provide alternate tools to use to manage things like depression, anxiety, and social challenges. If you've got other alternatives to achieving the relief from anxiety and depression, and better skills to achieve your interpersonal goals, the urge to self-medicate becomes less. NOT abusing substances becomes the more logical choice.

I can cite several examples and variations on this theme. In almost all cases, I trace it back to managing pain, anxiety and depression. Likewise, I can think of at least one person I know of who has some ADHD traits that turned to illegal stimulants. Is it possible that this person was unconsciously attempting to achieve the results they might get from taking prescription stimulants like Ritalin? I've always wondered.

All in all, I think this is an area that needs more study, and I think it's important that people who treat addiction build some understanding of autism so that they can better treat individuals who fall into this pattern. It may be that addiction is one of the many layers of coping mechanisms that some turn to to mask their the autistic traits. The question that leaves me with, is how can we better identify these adults, who may have effectively flown under the radar for years (and have years of trauma to show for it)? And once we've identified them, how can we give them the tools they need to live more satisfying lives?

It makes sense to me that repetitive behaviors used to feel safe could easily encompass substances. I have often felt that eating and chewing is a stim for me. I avoid alcohol because of anxiety and addictive tendencies in my family. I often feel that any thing I really like and find calming is hard to regulate, to not use to excess. Father and self are undiagnosed aspies; child is diagnosed.